Pentoxifylline added to RAS inhibitors slowed eGFR decline compared to control (between-group difference 4.3 ml/min per 1.73 m2; 95% CI 3.1-5.5; P<0.001) in patients with diabetic kidney disease.
RCT (n=169)
Open-label
randomized
Does pentoxifylline added to RAS blockade slow the progression of renal disease in patients with type 2 diabetes and stages 3-4 CKD?
The addition of pentoxifylline to RAS inhibitors significantly slowed eGFR decline and reduced residual albuminuria in patients with type 2 diabetes and stage 3-4 CKD.
Mean Difference: 4.3 (95% CI 3.1–5.5)
Tasa de eventos absoluta: 2.1% vs 6.5%
valor p: p=<0.001
Diabetic kidney disease (DKD) is the leading cause of ESRD. We conducted an open-label, prospective, randomized trial to determine whether pentoxifylline (PTF), which reduces albuminuria, in addition to renin-angiotensin system (RAS) blockade, can slow progression of renal disease in patients with type 2 diabetes and stages 3-4 CKD. Participants were assigned to receive PTF (1200 mg/d) (n=82) or to a control group (n=87) for 2 years. All patients received similar doses of RAS inhibitors. At study end, eGFR had decreased by a mean±SEM of 2.1±0.4 ml/min per 1.73 m(2) in the PTF group compared with 6.5±0.4 ml/min per 1.73 m(2) in the control group, with a between-group difference of 4.3 ml/min per 1.73 m(2) (95% confidence interval 95% CI, 3.1 to 5.5 ml/min per 1.73 m(2); P<0.001) in favor of PTF. The proportion of patients with a rate of eGFR decline greater than the median rate of decline (0.16 ml/min per 1.73 m(2) per month) was lower in the PTF group than in the control group (33.3% versus 68.2%; P<0.001). Percentage change in urinary albumin excretion was 5.7% (95% CI, -0.3% to 11.1%) in the control group and -14.9% (95% CI, -20.4% to -9.4%) in the PTF group (P=0.001). Urine TNF-α decreased from a median 16 ng/g (interquartile range, 11-20.1 ng/g) to 14.3 ng/g (interquartile range, 9.2-18.4 ng/g) in the PTF group (P<0.01), with no changes in the control group. In this population, addition of PTF to RAS inhibitors resulted in a smaller decrease in eGFR and a greater reduction of residual albuminuria.
Navarro‐González et al. (Fri,) conducted a rct in Diabetic kidney disease (n=169). Pentoxifylline vs. Control group (RAS inhibitors only) was evaluated on Decrease in eGFR (ml/min per 1.73 m2) (MD 4.3, 95% CI 3.1 to 5.5, p=<0.001). Pentoxifylline added to RAS inhibitors slowed eGFR decline compared to control (between-group difference 4.3 ml/min per 1.73 m2; 95% CI 3.1-5.5; P<0.001) in patients with diabetic kidney disease.